ENs take lead in primary mental health care

December 1, 2021

About 40 new enrolled nurse (EN) positions are being established in primary health care (PHC) over the next four years, to try and improve access to mental health and addiction (MH&A) services, particularly for Māori and Pacific people.

The EN workforce model – a Ministry of Health (MoH)– funded initiative – also aims to build the Māori and Pacific EN workforce.


ENs working in primary health care are relatively few and far between. Just 300 ENs work in PHC settings compared with 8500 registered nurses (RNs).1

The scope of EN practice2 sees them well-placed to work with community providers to offer a range of health services and promote equity.

However, misunderstandings and confusion around their scope, including the requirement for direction and delegation from an RN,3 together with the growth of the unregulated workforce (such as health-care assistants and health coaches), has seen PHC health providers often reluctant to employ an EN.

Within the programme, three approaches are emerging to increase the number of ENs working in PHC to provide integrated and holistic health care and take a key role in providing MH&A services.

The first is to develop the role of an existing EN, or create a new EN position, to focus on MH&A work.

One provider in Northland has employed a Māori EN to work with whānau who either underuse or overuse health (including secondary) services. A rural health provider in the South Island is developing the EN role to provide services for those isolated and disconnected from health services, after noticing an increase in drug and alcohol use and more complex mental health needs. In rural Northland, an EN is improving access to health care for wāhine Māori through the outreach cervical screening programme.

In all these cases, the ENs will be working with individuals and whānau to screen for MH&A concerns, assess and promote health, provide brief interventions and connect people with local services and resources.

The second approach is to develop clinical placements for EN students with health providers.

NorthTec’s EN programme leader Beth Cooper has worked closely with the EN workforce programme’s regional coordinator, Coral Wiapo, on matching students to ensure a good fit, including location and model of care – and the potential to employ the newly registered EN.

Student placements take place in the rehabilitation and community module of the 18-month EN diploma. From the first cohort of 10, three are now employed with community providers.

One new EN graduate, using a strength and resilience-based approach, will be providing free appointments to young people turning 16 to undertake both a HEEADSS (home, education, eating, activities, drugs and alcohol, suicide and depression, sexuality and safety) and general health assessment, promoting a positive health experience and behaviours, and connecting young people with community networks and services.

The third model is an apprenticeship model to support Māori and Pacific kaimahi at health providers to undertake EN training while continuing to work with, and be supported by, their employer. Given 71 per cent of the Māori workforce are unregulated,4 this model ensures that local priority communities receive care from appropriately trained health professionals. Additionally, there is the unquantifiable ripple effect of building the capability of whānau living and working in their community.

The programme is timely given the increasing complexity of people living with MH&A issues. Exciting models of care are emerging through this programme, which will showcase the significant scope of practice and different roles ENs can play in the community.

The initiative is a collaboration with health and education providers, as well as professional organisations such as NZNO, from across Aotearoa.

For further information, please contact Sue Adams.

Sue Adams, RN, PhD, is national NP/EN workforce programme co-leader, school of nursing, University of Auckland.
Josephine Davis, NP is national NP/EN workforce programme co-leader, school of nursing, University of Auckland.
Coral Wiapo, RN PGDip, is regional coordinator at Northland’s Mahitahi Hauora Primary Health Entity.
Beth Cooper, RN, MMgt (Health), PGCertTTL, is EN diploma programme leader at NorthTec.


  1. Nursing Council of New Zealand. (2019). The New Zealand Nursing Workforce: A profile of Nurse Practitioners, Registered Nurses and Enrolled Nurses 2018-2019. Te Kaunihera Tapuhi o Aotearoa/Nursing Council of New Zealand.
  2. Nursing Council of New Zealand. (n.d.). Tapuhi Kua Whakauru: Enrolled Nurse.
  3. Hughes, M., Kirk, R., & Dixon, A. (2018). New Zealand nurses’ storied experiences of direction and delegation. Nursing Praxis in New Zealand, 34(3), 32-45. doi.org/10.36951/NgPxNZ.2018.012.
  4. Sewell, J. (2017). Profiling the Māori health workforce 2017 (PDF, 1.91 MB). Te Rau Matatini.